Introduction/Background*Ultra-radical procedures have been introduced into surgical treatment of advanced epithelial ovarian cancer to better reach the goal of resection of all visible tumor from the abdominal cavity. This has enabled surgical treatment for patients with advanced and more widespread disease. The aim of this study was to evaluate the effect of this change in surgical paradigm on overall survival.
Methodology We collected retrospectively 247 patients with FIGO Stage IIIB-IVB ovarian, tubal and primary peritoneal carcinoma operated between 2013 and 2019 either by primary or interval cytoreduction in Tampere University Hospital. Patients were categorized into two groups and compared based on the date of the operation. Group 1 was operated between January 2013 and February 2016. Group 2 was operated between March 2016 and March 2019, during which time the change in surgical approach occurred. Groups were similar in age, ASA classification, tumor histology and primary vs interval debulking surgery rate. Patients were followed up to November 2020.
Result(s)*Complete cytoreduction (R0) increased from 14% to 54% in Stage III patients and from 23% to 49% in Stage IV patients after the change in surgical approach towards ultra-radical surgery. The proportion rate of Stage IV patients increased slightly from 31% in Group 1 to 40% in Group 2 (p=0.145). The median follow-up was 28.7 months (0.5–92.7). In all stages combined, the median OS increased from 33.5 months in Group 1 to 54.5 months in Group 2 (p=0.028). The median OS for stage III patients in Group 1 was 36.1 months (27.4 – 44.8) but could not be reached in Group 2 (p=0.009). In Stage IV patients, OS was 32.0 months (16.4 – 47.7) and 39.3 months (24.8 – 53.8) in Group 1 and 2, respectively (p=0.691).
Conclusion*The change of surgical approach towards ultra-radical techniques improves overall survival of patients with advanced epithelial ovarian cancer, but the survival benefit is only seen in stage III patients.
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